Rule breakers achieve successful shoulder balance: unraveling the myth of upper instrumented vertebrae selection criteria.

Purpose: This study compared shoulder balance outcomes in "rule breakers" (RB) vs. "rule followers" (RF) based on commonly utilized upper instrumented vertebrae (UIV) selection guidelines.

Methods: Adolescent idiopathic scoliosis (AIS) patients (Lenke 1-4) who underwent posterior spine fusion (PSF) with minimum 2-year follow-up had radiographic measurement of shoulder balance including first rib angle (FRA), T1 tilt, coracoid process height difference (CPHD), and clavicle angle (CA) at preop, postop, 6-month, 1-year, and 2-year timepoints.

A Pathway for the Diagnosis and Treatment of Lumbar Spinal Stenosis.

Lumbar spinal stenosis is a prevalent condition with varied presentation. Most common in older populations, symptoms typically include back, buttock, and posterior thigh pain. Diagnosis is typically based on physical examination and clinical history, but confirmed on imaging studies.

Degenerative Cervical Myelopathy: Evaluation and Management.

Degenerative cervical myelopathy is most commonly caused by cervical spondylosis, with a predominant elderly population, and is the most common cause of spinal cord impairment. Patients typically present with gait dysfunction, hand impairment, and/or the presence of long tract signs: clonus, Hoffman sign, Babinski sign, or inverted radial reflexes. One of the key surgical strategies is deciding an approach, which is based on patient characteristics and cause of pathologic condition.

Gunshot Wounds to the Hip: Doomed to Failure?

The purpose is to evaluate hip fractures due to gunshot wounds (GSW) to the hip, which are treated surgically, and the complications. Patients who sustained a low velocity GSW with fracture to the femoral head/neck and intertrochanteric/peritrochantric region at three Level 1 Trauma Centers were eligible. There were 69 patients (63 males-91%), with an average age of 29 (18-60).

Characterizing solution surface loop conformational flexibility of the GM2 activator protein.

GM2AP has a β-cup topology with numerous X-ray structures showing multiple conformations for some of the surface loops, revealing conformational flexibility that may be related to function, where function is defined as either membrane binding associated with ligand binding and extraction or interaction with other proteins. Here, site-directed spin labeling (SDSL) electron paramagnetic resonance (EPR) spectroscopy and molecular dynamic (MD) simulations are used to characterize the mobility and conformational flexibility of various structural regions of GM2AP. A series of 10 single cysteine amino acid substitutions were generated, and the constructs were chemically modified with the methanethiosulfonate spin label.

Effects of PRE and POST therapy drug-pressure selected mutations on HIV-1 protease conformational sampling.

Conformational sampling of pre- and post-therapy subtype B HIV-1 protease sequences derived from a pediatric subject infected via maternal transmission with HIV-1 were characterized by double electron-electron resonance spectroscopy. The conformational ensemble of the PRE construct resembles native-like inhibitor bound states. In contrast, the POST construct, which contains accumulated drug-pressure selected mutations, has a predominantly semi-open conformational ensemble, with increased populations of open-like states.

The safe patient flow initiative: a collaborative quality improvement journey at Yale-New Haven Hospital.

Background: Yale-New Haven Hospital (YNHH) began a successful journey to achieve safe patient flow in fiscal year (FY) 2008 (October 1, 2007-September 30, 2008). The 966-bed (now 1,541-bed) academic medical center faced several challenges, including overcrowding in the Adult Emergency Department (ED); delays in the postanesthesia care unit, which affected the flow of patients through the operating rooms; pinched capacity during the central part of the day; and a lack of interdependent institutionwide coordination of patients.

Methods: The Safe Patient Flow Steering Committee oversaw improvement efforts, most of which were implemented in FY 2009 (October 2008-September 2009), through a cascade of operational meetings.